Healthcare Provider Details

I. General information

NPI: 1699522060
Provider Name (Legal Business Name): SIERRA HENDRICKSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 W 31ST ST
LAWRENCE KS
66047-3042
US

IV. Provider business mailing address

3312 CLINTON PKWY
LAWRENCE KS
66047-3624
US

V. Phone/Fax

Practice location:
  • Phone: 785-843-9262
  • Fax:
Mailing address:
  • Phone: 785-312-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number04420
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01339
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: